Headache and Dizziness

Headaches

Almost everybody gets headaches – 96% of people, to be exact. There are many different types of headaches, with many different causes. Because headaches often involve the brain, they may feature neurological symptoms that accompany the head pain, particularly visual disturbances. One type of neurological symptom that commonly co-occurs with headache is dizziness.

Headache on its own can be a bothersome symptom and a significant source of disability for some individuals. Some headaches can even cause several days of loss of function each time they occur. When you add dizziness to a headache, the difficulties and dysfunction inevitably worsen. Dizziness in its own right can be a disturbing and disruptive symptom, as well as a cause of falls and other accidents.

There are over 200 types of headaches described in the medical literature. Among the most common types of headache are:

• Migraines – throbbing and pulsating pain, often severe, usually on one side of the head. These tend to be recurrent, and the causes are not well understood,
• Tension headaches – these are due to muscle tension, often brought on by poor posture, stress, and muscle tension, weakness, or imbalance,
• Cervicogenic headaches – pain that originates from the neck and back of the head, and
• Cluster headaches – intense pain behind one eye.

Dizziness

There are a variety of symptoms that people describe as “dizziness,” but they can be divided into five salient types:

1. Lightheadedness – the feeling that one is about to faint,
2. Vertigo – the false sensation that one is swaying, or spinning, or that the environment is moving,
3. Motion Sickness/Visual Sensitivity – this is the feeling you get being on a boat or riding in the back seat of a car, 
4. Psychophysiological dizziness – an “out-of-body” sensation, as if one is floating, or spinning through the air, and
5. Disequilibrium – the feeling of being off-balance or moving due to sensory conflict, where what is seen and what is felt do not match. 

Each type of dizziness has different causes and different treatments, so identifying the exact nature of the dizziness is critical. Although dizziness is a distressing symptom and can be disabling, safety is a major concern because of the significant risk for falls and other accidents. 

Migraines

Migraines are often accompanied by neurological symptoms, including dizziness. This is probably due to transient changes in the brain chemistry (especially to brain chemicals known as neurotransmitters) prior to and during migraines. People may experience a variety of symptoms that result from abnormal brain function from these changes, such as:

• Nausea and vomiting,
• Visual disturbances,
• Difficulty speaking,
• Sensory changes (such as feelings of pins and needles in the limbs),
• Hallucinations (seeing or hearing things that are not there), and
• Dizziness.

Virtually any kind of dizziness can occur with migraines. Migraines that are associated with vertigo are known as “vestibular migraines,” which we will discuss next.

Vestibular Migraine

Vestibular migraine is a relatively common type of headache where vertigo occurs concurrently with an otherwise typical migraine. People with this type of headache will sometimes (but not always) feel vertigo and disequilibrium during one of their migraine attacks. 

Vestibular migraines are characterized by recurrent migraine headaches that sometimes include vertigo lasting 5 minutes to 72 hours. The headache may include any of the following features:

• Moderate to severe in intensity,
• Pulsating,
• Located on one side of the head,
• Worsened by physical activity, and
• Intolerance of light and noise.

Vestibular migraine is diagnosed in about 7% of people who are seen in dizziness clinics, and 9% of people who present to headache clinics.

As with any recurrent migraines, vestibular migraines can be treated by “attack therapy,” where a medication is taken when the headache occurs, and “prophylactic therapy,” where a medication is taken daily to prevent the headache and dizziness. \

Concussion and Post-Concussion Syndrome

A concussion is a type of injury to the brain caused by trauma, such as a blow to the head, or the head being rapidly jerked back and forth. 

A “syndrome” is a group of symptoms that usually occur together from a common cause. So… “post-concussion syndrome” is a group of symptoms that can occur together in someone who has suffered a concussion at some point in the past. Two of the symptoms that can occur together following a concussion are headache and dizziness.

In the immediate period following head trauma, a concussion can cause various types of dizziness, in the form of vertigo, disequilibrium, and lightheadedness, as well as headache or a feeling of pressure in the head. Concussed individuals are often off-balance following the head trauma, and this may be compounded by visual disturbances and a feeling of being groggy.

Concussion symptoms may start immediately following the head trauma, or they may arise hours or even days later. Sometimes the symptoms are few and mild to begin with, and more symptoms and greater intensity develop over days.  There are a huge variety of symptoms that can occur in concussion syndromes besides headache and dizziness, such as:

• Amnesia (forgetting events before or after the head trauma),
• Confusion,
• Loss of consciousness,
• Odd behaviors, mood swings, and personality changes,
• Nausea and/or vomiting, and
• Sensitivity to light and noise.

In 80-90% of cases, people who experience symptoms from a concussion see their symptoms resolve within two weeks. When concussion symptoms persist for weeks or months the individual is said to have post-concussion syndrome. Post-concussion syndrome does not usually occur after a single episode of head trauma; the condition is usually seen in individuals with accumulated concussions. 

Hypoglycemia

Hypoglycemia (low levels of the sugar glucose in the blood) can cause a variety of symptoms. It commonly causes dizziness – usually in the form of lightheadedness – and this may occasionally be accompanied by a headache.

Hypoglycemia can occur in diabetics who have taken too much insulin, or whose dose of oral medications is too high. Even diabetics who are on the correct dose of medications can experience hypoglycemia if they miss meals or snacks, and sometimes it just happens for unexplained reasons.

Hypoglycemia can occur in non-diabetics as well. The co-occurrence of headache and dizziness is more common in non-diabetic hypoglycemia than it is in diabetics. There are several ways hypoglycemia can happen in non-diabetics:

• Reactive hypoglycemia – this is a phenomenon where hypoglycemia occurs, paradoxically, after eating; usually within four hours after the meal. It is caused by insulin levels that are too high in response to eating, which drives the blood sugar too low. There are a variety of causes of reactive syndrome,
• Non-reactive hypoglycemia – this is hypoglycemia that occurs for reasons not linked to eating, most commonly due to inadequate nutrition, or due to medication effects, and
• Dumping syndrome – this occurs in people who have had stomach surgery, such as gastric bypass for weight loss, or surgery to correct bleeding ulcers. People must follow prescribed diets following stomach surgery, and if they do not eat properly their insulin levels may spike, leaving them hypoglycemic after the small-sized stomach “dumps” the nutrients too quickly.

Hypoglycemia commonly causes dizziness, and less commonly headache. The headache is usually generalized around the head or may be located at the temples. It is usually described as throbbing and dull in nature. Hypoglycemia can also trigger migraines in those who are prone to these types of headaches.

Sugar Hangover

Although “sugar hangover” is not a well-defined concept in the medical literature, the concept is well known to medical practitioners and the people who experience these uncomfortable episodes. 

A sugar hangover refers to the very high blood sugar (hyperglycemia) that follows eating a high concentration of simple sugars (such as in sweets and candy), that is soon followed by low blood sugar (hypoglycemia). Both situations can bring on headache and dizziness.

Complex carbohydrates – such as starches and dietary fibers – take a long time for the body to break down and process, so they are absorbed into the bloodstream gradually, over hours, after eating. Simple carbohydrates – such as processed sugars in sweets – are easily absorbed by the body, so they are absorbed very rapidly after eating, hitting the blood stream virtually all at once. 

When people eat a large dose of simple carbohydrates, they get a rapid spike in blood sugar that overpowers the body’s ability to produce insulin to handle the sugar. The resulting hyperglycemia can trigger a sugar hangover. The hyperglycemia is known to cause headaches, fatigue, lightheadedness, increased thirst, and an overall feeling of being unwell.

The body switches into maximum insulin production to correct the hyperglycemia, and the high insulin levels may in turn result in a reactive hypoglycemia, which can also cause headache and dizziness, as we discussed in the previous section.

Although sugar hangovers can cause uncomfortable symptoms, they are not dangerous to the health. In diabetics, however, extremes of blood sugar – either high or low – can be life-threatening. Hyperglycemia in diabetics can bring on symptoms that may be more extreme than in non-diabetics and can trigger a life-threatening condition known as diabetic ketoacidosis. Hypoglycemia in diabetics can cause dizziness (mostly lightheadedness) that progresses to loss of consciousness, coma, and death.

Sugar hangovers and the headache and dizziness that they may bring on can be avoided by eating well-balanced meals, avoiding excess refined sugar intake. Diabetics must be extra-careful to avoid extremes in blood sugar, which can usually be avoided by good diabetic self-care.

Meniere’s Disease

Meniere’s disease is a chronic disorder of the inner ear characterized by recurrent vertigo, hearing loss, aural fullness, and ringing in the ear (tinnitus). Although headache is not a typical feature of Meniere’s disease, headaches are infrequently reported to accompany the vertigo. Episodes of vertigo may also trigger a migraine in prone individuals with Meniere’s disease.

Headache and Dizziness Treatment 

The treatment of headache and dizziness depends entirely upon the cause of the symptoms, so diagnosis is especially important. As well, determining whether the dizziness and headache are due to the same cause is equally important.

With or without headache, the safety concerns associated with dizziness, as well as the adverse effects on lifestyle, make diagnosis and treatment of dizziness important. As well, dizziness – particularly when accompanied by headache – may be a symptom of a larger underlying problem, so it should never be ignored. The most important aspect of the management of headache and dizziness is identifying and correcting the underlying cause. 

When dizziness is chronic and recurrent, an important part of treatment includes symptom management to prevent injury from falls and to optimize day-to-day function. In such cases, access to a physical therapist with expertise in diagnosing and treating dizziness becomes important. Balance and gait therapy are an important part of the overall management plan for people who experience any kind of dizziness and instability.

Many people are not aware that physiotherapy is a difference-making treatment for many of the more common types of headaches, including migraines and tension-type headaches. An expert assessment by a physiotherapist may pinpoint some key causative factors that can be directly addressed. This includes such modifiable factors as:

• Stress effects,
• Poor or imbalanced posture,
• Cervical spine trauma or stiffness,
• Prolonged sitting at a desk,
• Improper sleep position, 
• Muscle tightness and spasm, and 
• Muscle weakness and imbalances.

Specially trained physical therapists can assess each patient’s symptoms to customize the optimal treatment approach for that individual’s specific type of headache and dizziness. Therefore, expertise in treating headaches and vertigo and other types of dizziness is important when selecting a physical therapist.

FYZICAL® Therapy & Balance Centers provide specialized physical therapy for a wide variety of musculoskeletal, neurological, visual, and inner ear conditions that cause dizziness and poor balance, including dizziness after eating.

The dizziness treatment program at FYZICAL uses established proprietary treatment and recovery protocols that include specialized cutting-edge equipment that is not available at other physical therapy centers. This makes the specialized physical therapists at FYZICAL an excellent choice for those seeking relief from headache and dizziness of any kind.

FYZICAL offers free assessments to diagnose dizziness and to determine each individual’s falling risk. The physical therapists at FYZICAL will then create a recovery program tailored to each patient’s specific condition and needs.

FYZICAL offers a wide variety of physical therapy services by qualified providers across the U.S. To find a FYZICAL Therapy & Balance Center near you, visit our website at FYZICAL.com. Our highly skilled therapy providers are 100% focused on your optimal health so you can Love Your Life®!

To learn more about how FYZICAL Therapy & Balance Centers can help you, download our free e-book.